不同预后的自身免疫性肝炎所致的肝功能衰竭临床特点以及肝组织学特征的比较

Comparative analysis of clinical and histological features in liver failure due to autoimmune hepatitis with varied prognoses

目的比较不同预后的自身免疫性肝炎所致肝功能衰竭(autoimmune hepatitis related liver failure,AIH-LF)临床特点以及肝组织学特征。方法选取2022年6月至2023年6月东部战区总医院诊治的AIH-LF患者150例,根据预后分为缓解组74例,无效组76例。比较两组患者的临床特点及肝组织学特征。结果无效组病程>6个月的患者为42例(55.3%)、慢加急性肝衰竭43例(56.6%)、出血21例(27.6%)、AFP为(112.2±26.3)ng/mL、MELD评分为27.54(23.4,30.1)分,缓解组分别为23例(31.1%)、27例(36.5%)、10例(13.5%)、(144.6±30.9)ng/mL、20.3(18.9,26.4)分,差异有统计学意义(P<0.05)。两组患者的血清抗体ANA、AMA和P-ANCA检出率无明显差异(P>0.05)。缓解组患者的LKM-1和SLA/LP检出率分别为2例(2.7%)和3例(4.1%),无效组分别为11例(14.5%)和16例(21.1%),差异有统计学意义(P<0.05)。两组的肝组织学比较,缓解组患者的界面性肝炎率、肝纤维化F2期率高于无效组(P<0.05),而门静脉炎症率、胆管损伤率、浆细胞浸润率、小叶性肝炎率和玫瑰花结形成率低于无效组(P<0.05)。结论不同预后的AIH-LF患者临床特点及肝组织学特征有差异,与预后好的患者相比,预后差的AIH-LF患者AIH病程更长、出血症状更多,肝组织的门静脉炎症、胆管损伤以及肝纤维化更严重。

Objective To compare the clinical and histological characteristics of autoimmune hepatitis-related liver failure(AIH-LF)across different prognostic outcomes.Methods A total of 150 patients with AIH-LF admitted for treatment between June 2022 and June 2023 were selected for this study.Following standardized treatment,the patients were categorized into a remission group and an ineffective group based on their prognoses.Clinical data and examination results were retrospectively collected,and the clinical and liver histological characteristics were compared between the two groups.Results Based on the prognosis,74 patients were classified into the remission group,and 76 cases into the ineffective group.In the ineffective group,42 cases(55.3%)had a disease course exceeding 6 months,43 cases(56.6%)presented with chronic and acute features,21 cases(27.6%)experienced bleeding,the AFP level was 112.2±26.3 ng/mL,and the MELD score was 27.54(23.4,30.1).The differences between the ineffective group and the remission group were statistically significant(P<0.05).No significant differences were found in the detection rates of serum antibodies ANA,AMA,and P-ANCA between the two groups(P>0.05).However,the detection rates of LKM-1 and SLA/LP were 2 cases(2.7%)and 3 cases(4.1%)in the remission group,respectively,compared to 11 cases(14.5%)and 16 cases(21.1%)in the ineffective group,with statistical significance(P<0.05).When comparing liver histology,the remission group exhibited a higher rate of interfacel hepatitis and F2 phase liver fibrosis compared to the ineffective group(P<0.05).In contrast,the ineffective group had higher rates of portal vein inflammation,bile duct injury,plasma cell infiltration,lobular hepatitis,and rosette formation(P<0.05).Conclusion The clinical and liver histological characteristics of AIH-LF patients vary significantly based on their prognoses.Compared to patients with a favorable prognosis,those with a poor prognosis tend to have a longer course of AIH,more frequent bleeding symptoms,and more severe portal vein inflammation,bile duct injury,and liver fibrosis.These findings provide valuable insights for clinical diagnosis and treatment strategies.